Aspergillus Osteomyelitis of Clivus

A 64-year-old man presented with a 2-month history of headache. The patient had a history of 30 years of diabetes. Magnetic resonance imaging revealed a lesion involving the sphenoid sinus and clivus. Surgery was performed through a transsphenoidal approach. Pathology suggested the diagnosis of the presence of Aspergillus. The patient received voriconazole treatment for 8 weeks, and 3-month follow-up demonstrated no progression. Aspergillus osteomyelitis of the skull base is uncommon, and accurate preoperative diagnosis is difficult. However, when there is a clear history of diabetes, a diagnosis of fungal osteomyelitis should be considered.